HIV patient from London could hold the key to AIDS cure

New research on a 59-year old member of a very rare group of HIV+ patients referred to as “elite controllers” has revealed exciting new evidence that could guide scientists towards the development of a cure for the devastating virus.

The immune system of an elite controller is naturally better at combatting the HIV virus which means they can often go much longer without treatment. However members of this group, which represents approximately 0.3% of HIV sufferers, will eventually need medical treatment to prevent the progression to AIDS.

The study, led by UCL, the University of Oxford and the University of North Carolina at Chapel Hill, involved a man who suffered from both HIV and myeloma, a cancer of the bone marrow.

The bone marrow produces white blood cells, including those that help to control HIV. To treat the patient’s myeloma, his bone marrow was completely removed and replaced using his own stem cells. When the bone marrow was removed, the immune system was severely impaired, allowing the HIV to re-activate, replicate and multiply.

When the patient’s immune function returned about two weeks after the transplant, the levels of HIV in his bloodstream rapidly fell. His immune system reduced HIV levels at a similar rate to the most powerful treatments available, bringing them back down from 28,000 to 50 copies per ml within six weeks.

“By measuring the strength of the immune system required to keep this virus under control in this rare individual, we have a better idea of the requirements for successful future treatment,” says co-author Professor Deenan Pillay (UCL Infection & Immunity). “We also managed to identify the specific immune cells that fought the infection. This is a single patient study, but nevertheless it is often the unusual patients who help us to understand the HIV disease process.”

The results of the study revealed that the mechanisms associated with this particular patient’s immune system had enabled him to handle large bursts of HIV activity and so it should be possible to cure the deadly virus with a ‘kick and kill’ strategy.

“Kick and kill” involves stimulating the immune system with a vaccine, then re-awakening dormant HIV strands hiding in white blood cells with a chemical ‘kick’ so that the boosted immune system would then locate and kill them. Basically flushing out the HIV virus so that white blood cells can destroy any remaining strands.

Until now it was unclear whether the human immune system would be able to control HIV following full-blown reactivation of the virus. However this insightful new research, published in Clinical Infectious Diseases, demonstrates that this has been possible in a single patient case study.

Dr Ravi Gupta (UCL Infection & Immunity) said: ‘The immune system can be as powerful as the most potent drug cocktails. This study takes us one step closer by showing us what type of immune responses an effective vaccine should induce.’

His colleague Professor Deenan Pillay, said: ‘By measuring the strength of the immune system required to keep this virus under control in this rare individual we have a better idea of the requirements for successful treatment.’

Dr Gupta that although the results looked ‘promising’, they would be unlikely to lead to a cure for at least a decade.

Although current antiretroviral treatments can suppress HIV and delay the onset of Aids for many years it cannot rid the body of the virus completely. Check out some of the more recent statistics regarding UK and Ireland HIV infection rates below:

In 2013, 344 people were newly diagnosed with HIV in Ireland, giving a rate of 7.5 per 100,000 population.

258 Males and 86 females

Average age of new diagnosis was 34.

The highest proportion of new diagnoses in 2013 (46.2%) were among men who have sex with men (MSM).

Heterosexual contact accounted for 38.1% of new diagnoses. Among the heterosexual cases, 57% were among individuals originating from countries with generalised epidemics, 8% had a high‐risk partner or a partner known to be HIV positive

2% or 18 people of new diagnoses were among Injecting Drug Users (IDUs).

Three Mother to Child Transmission (MTCT) cases were diagnosed.

Ireland was reported as the country of birth for 141 new diagnoses (41%) with 174 reportring as not born in Ireland.

Of the newly diagnoses in 2013 with CD4 count available (88%), 50% were reported as late presenters (CD4 count of <350 cells/mm3), compared with 48% in 2012 and 52% in 2011. The proportion of those diagnosed late varied by risk group and was highest among heterosexuals (59%) and PWID (56%). 25% of people were severely immuno-compromised at diagnosis. 27 cases (8%) were diagnosed with an AIDS defining illness at the time of their HIV diagnosis.

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